EVAR practice and outcomes since 1996
Martin Hennessy
22/08/2019
1 Details about all EVARs performed
- This document covers EVARs performed between 1996-09-19 and 2019-08-29
- This comprises 881 EVARs
1.1 Indication
1.1.1 Number of EVAR for each indication
- Both ruptured and symptomatic aneurysms are judged by available clinical information
- Open repair issue is usually pseudoaneurysm formation
1.2 Site
1.2.1 Numbers of EVAR at each site
All years; FV = Forth Valley, GG & C = Greater Glasgow and Clyde
1.2.2 Numbers of EVAR for each indication at each site
All years, all indications
1.3 Gender
1.3.1 Number of EVARs performed by gender
All sites, all years, all indications
1.4 Year
1.4.1 Number of EVARs performed each year
All sites, all indications
1.5 Year Group
- To visualise the data about years a different way, the data are grouped into ‘year groups’ of five years, eg. 2010-2014, 2015-2019 etc
1.5.1 Number of EVARs performed in each year group
All sites, all indications
2 Details about elective EVARs performed
- Subsections below relate to EVARs performed for elective abdominal aortic aneurysms only
2.1 Number of elective EVARs
- 802 elective EVARs have been performed in all sites
2.2 Site
2.2.1 Number of elective EVARs at each site
Elective EVARs, all years; FV = Forth Valley, GG & C = Greater Glasgow and Clyde
2.3 Gender
2.3.1 Number of elective EVARs by gender
Elective EVARs; all sites, all years
2.3.2 Number of elective EVARs performed by gender of patients at each site
Number of elective EVARs performed, split between men and women, separated by site
2.4 Age
- Boxplots are used frequently in this section
- Here is a reminder of what a boxplot displays:
- The ‘box’ represents the interquartile range (IQR) of the data
- In other words, 50% of the patients fall between this age range
- The thick black horizontal line is the median age
- The thin black vertical lines extend to the upper and lower limits of age
- Black dots represent outliers (above or below 3 x IQR)
2.4.1 Age of patients undergoing elective EVAR
- A barplot displaying the number of patients undergoing elective EVAR at each age:
Elective EVARs; all sites, all years
- Median and mean ages for elective EVARs:
| Median | Mean |
|---|---|
| 74 | 74.1 |
- Age expressed as a boxplot:
Elective EVARs; all sites, all years
2.4.2 Age of patients at each site
- Boxplot of age at each site:
Elective EVARs; all years
- Median and mean age at each site:
| Site | Median | Mean |
|---|---|---|
| GG & C | 74 | 74.1 |
| FV | 74 | 73.5 |
2.4.3 Age of patients by gender
Elective EVARs; all sites, all years
- Median and mean age by gender:
| Gender | Median | Mean |
|---|---|---|
| Man | 74 | 73.9 |
| Woman | 77 | 75.9 |
2.4.4 Age of patients undergoing elective EVAR by decade of life
- The number of elective EVARs by age of patient, grouped by decade of life:
Elective EVARs; all sites, all years
- Due to the small number of patients, those who were in their 6th or 10th decades at time of elective EVAR are ommitted from the following.
- Boxplot of spread of ages in 7th, 8th or 9th decade:
All sites, all years
- Patients in their 7th decade skew slightly towards the upper aspect of that decade
- Patients in their 8th decade, the decade in which most elective EVARs are performed, are evenly spread
Patients in their 9th decade skew greatly towards the young ages of that decade
The median and means from the above boxplot are shown in this table:
| Decade | Median | Mean |
|---|---|---|
| 7th | 66 | 66.0 |
| 8th | 75 | 74.6 |
| 9th | 82 | 82.5 |
2.5 Year
2.5.1 Number of elective EVARs each year
Elective EVARs; all sites
2.5.2 Number of elective EVARs each year at each site
Elective EVARs
2.5.3 Age of patients having elective EVAR each year
Elective EVARs; all sites
2.6 Year Group
2.6.1 Number of elective EVARs performed in each year group
Elective EVARs; all sites
2.6.2 Number of elective EVARs performed in each year group at each site
Elective EVARs
2.7 Stent-graft
2.7.1 Number of stent-grafts used for elective EVAR across all sites
Elective EVARs; all sites, all years
2.7.2 Number of stent-grafts used for elective EVAR at each site
Elective EVARs; all years
2.7.3 Number of stent-grafts used for elective EVAR each year
Elective EVARs; all sites
2.7.4 Number of stent-grafts used for elective EVAR each year group
Elective EVARs; all sites
2.8 Seal zones and complexity
- This section deals with seal zones for performed EVARs
- Supra-renal seals comprises fEVAR and chEVAR
- For the iliacs, CIA = common iliac artery, EIA = external iliac artery, AUI = aorto-uni-iliac device, IBD = iliac branch device
- For AUI, the side where AUI is recorded is the occluded side (the contralateral side could be CIA, EIA etc.)
- For IBD, seal in EIA is assumed
- EVAR is considered complex if supra-renal fixation was used (fEVAR of chEVAR) or if an iliac branch device was used
- Any other factors regarding complexity have not been taken in to account
2.8.1 Aortic seal zones for elective EVAR across all sites
Elective EVARs; all sites, all years
2.8.2 Aortic seal zones for elective EVAR for each site
Elective EVARs; all years
2.8.3 Iliac seal zone for elective EVAR across all sites
2.8.3.1 All iliacs
Elective EVARs; all sites, all years
2.8.3.2 Left and right iliacs plotted separately
Elective EVARs; all sites, all years
2.8.4 Complexity of elective EVAR across all sites
Elective EVARs; all sites, all years
2.8.5 Complexity of elective EVAR for each site
Elective EVARs; all years
2.8.6 Complexity of elective EVAR each year
Elective EVARs; all sites
2.8.7 Complexity of elective EVAR each year group
Elective EVARs; all sites
2.9 Access method for elective EVAR
- This section refers to lower limb access
- Upper limb access, for whatever reason it was required, is not included
- Four options for access are available:
- “Unknown” if the access method can not be ascertained
- “Cut down” if surgical cut down to all access vessels was used
- “Hybrid” if percutaneous access was used for one vessel, cut down for the other
- “Perc” if percutaneous access was used for all access
- Failed access refers to any percutaneous access for which a cut-down was required to achieve haemostasis
- Endovascular measures to achieve haemostasis are not considered a failure
2.9.1 Access methods for elective EVAR across all sites
Elective EVARs; all sites, all years
2.9.2 Access methods for elective EVAR per site
Elective EVARs; all years
2.9.3 Access methods for elective EVAR per year
Elective EVARs; all sites
2.9.4 Access methods for elective EVAR per year group
Elective EVARs; all sites
2.9.5 Success of percutaneous access
Elective EVARs; all sites, all years
2.9.6 Success of percutaneous access per site
Elective EVARs; all years
2.9.7 Success of percutaneous access per year
Elective EVARs; all sites
2.9.8 Success of percutaneous access per year group
Elective EVARs; all sites
2.10 Mode of anaesthesia for elective EVAR
- Three options for anaesthesia are available:
- “General” if the patient was under general anaesthetic
- “Spinal” if the patient was under spinal anaesthetic
- “Local” if local anaesthetic was used
- Information is taken from radiology reports and where no method of anaesthetic is provided, general anaesthetic is assumed
- Patients converted, eg from local to general anaesthetic, are considered to be general anaesthetic cases
2.10.1 Anaesthetic method for elective EVAR across all sites
Elective EVARs; all sites, all years
2.10.2 Anaesthetic methods for elective EVAR per site
Elective EVARs; all years
2.10.3 Anaesthetic methods for elective EVAR per year
Elective EVARs; all sites
2.10.4 Anaesthetic methods for elective EVAR per year group
Elective EVARs; all sites
2.11 Survival after elective EVAR
2.11.1 Thirty day survival
2.11.1.1 Thirty day survival after elective EVAR across all sites
Elective EVARs; all sites, all years
2.11.1.2 Thirty day survival after elective EVAR by site
Elective EVARs; all years
2.11.1.3 Thirty day survival after elective EVAR by gender
Elective EVARs; all sites, all years
2.11.1.4 Thirty day survival after elective EVAR by decade of life
Elective EVARs; all sites, all years
2.11.1.5 Thirty day survival after elective EVAR by year group performed
Elective EVARs; all sites
2.11.1.6 Thirty day survival after elective EVAR by access method
Elective EVARs; all sites, all years
2.11.2 Five year survival
2.11.2.1 Five year survival after elective EVAR across all sites
Elective EVARs; all sites, all years
2.11.2.2 Five year survival after elective EVAR by site
Elective EVARs; all years
2.11.2.3 Five year survival after elective EVAR by gender
Elective EVARs; all sites, all years
2.11.2.4 Five year survival after elective EVAR by decade of life
## Warning: Removed 1 rows containing missing values (geom_path).
## Warning: Removed 1 rows containing missing values (geom_path).
Elective EVARs; all sites, all years
2.11.2.5 Five year survival after elective EVAR by year group performed
Elective EVARs; all sites
2.11.2.6 Five year survival after elective EVAR by access method
Elective EVARs; all sites, all years
2.11.3 Ten year survival
2.11.3.1 Ten year survival after elective EVAR across all sites
Elective EVARs; all sites, all years
2.11.3.2 Ten year survival after elective EVAR by site
Elective EVARs; all years
2.11.3.3 Ten year survival after elective EVAR by gender
Elective EVARs; all sites, all years
2.11.3.4 Ten year survival after elective EVAR by decade of life
Elective EVARs; all sites, all years
2.11.3.5 Ten year survival after elective EVAR by year group performed
Elective EVARs; all sites
2.11.4 Overall survival
2.11.4.1 Survival after elective EVAR across all sites
Elective EVARs; all sites, all years
2.11.4.2 Survival after elective EVAR by site
Elective EVARs; all years
2.11.4.3 Survival after elective EVAR by gender
Elective EVARs; all sites, all years
2.11.4.4 Survival after elective EVAR by decade of life
Elective EVARs; all sites, all years
2.11.4.5 Survival after elective EVAR by year group performed
Elective EVARs; all sites
2.12 Re-interventions after elective EVAR
- This section details the number of patients who have a re-intervention after elective EVAR and the number of re-interventions those patients have
- Re-intervention survival is also presented
2.12.1 Number of patients have re-interventions and number of re-interventions
Elective EVARs; all years, all sites
- In other words:
- 34 of 161 patients had a re-intervention
- This is 21 percent of patients
- They average 1.8 re-interventions per patient
2.12.2 Re-intervention survival
Elective EVARs; all years, all sites
2.13 Limb occlusion
- This section deals with limb occlusion after EVAR
- The internal iliac artery component of an iliac branch device is not considered, only the external or common iliac arteries
- The occluded side on AUI is discounted
- For IBD, seal in EIA is assumed and so these are merged
2.13.1 Number of limb occlusions
2.13.1.1 All iliacs
Elective EVARs; all years, all sites
2.13.1.2 Left and right iliacs plotted separately
Elective EVARs; all years, all sites
2.13.1.3 Number of limb occlusions by iliac seal zone
Elective EVARs; all years, all sites
2.13.1.4 Number of limb occlusions by site
Elective EVARs; all years
2.13.2 Number of limb occlusions by year
Elective EVARs; all sites
2.13.2.1 Number of limb occlusions by year group
Elective EVARs; all sites
2.13.3 Number of limb occlusions by device
Elective EVARs; all years, all sites
2.13.4 Occlusion free survival
2.13.4.1 Occlusion free survival for all cases
Elective EVARs; all years, all sites
2.13.4.2 Occlusion free survival by iliac seal zone
- IBD has been merged in to EIA
Elective EVARs; all years, all sites
2.13.4.3 Occlusion free survival by device
- Data have been filtered to include only devices with 50 or more iliac seals
Elective EVARs; all years, all sites